A key to decreasing HIV risk among Asian Pacific sex workers lies in eradicating stigmatizing laws, according to a report released this month by the United Nations Development Program (UNDP). The report explores various barriers affecting the ability of sex workers to make sexual health decisions such as the use of condoms as evidence of prostitution, denial of identity documents, and lack of labor rights.

The 210-page report, entitled Sex Work and the Law in Asia and the Pacific, documents laws, legal statuses, and law enforcement policies targeting sex workers in 48 Asian and Pacific countries, assessing their impact on the human rights of those targeted. The report also provides recommendations for how to create legal and healthcare frameworks that empower sex workers to reduce their risk around HIV.

Mandeep Dhaliwal, director of HIV, Health and Development Practice at UNDP, stated, "Globally, [female] sex workers are 14 times more likely to acquire HIV than other women of reproductive age, yet fewer than 1 in 5 has access to HIV prevention, treatment and care."

However, in countries in which HIV is decriminalized or legalized -- such as New Zealand and Australia -- condom use is high and sexually transmitted infection (STI) rates are lower than those of the general population.

Using a literature review in addition to interviews with sex workers, sex worker organizations, UN agencies, and technical experts, the report gathered comprehensive information about the various systems of regulation and criminalization across the Asiatic Pacific region and their health and safety outcomes

Some ways in which criminalization was found to increase vulnerability to HIV were:

Report author John Goodman, an Australian human rights lawyer, highlights the importance of clear differentiation between sex trafficking and consensual sex work, stating that the conflation of human trafficking and sex work as "sexual exploitation" reinforces stigma and creates barriers to accessing HIV services. Forced rescue and rehabilitation efforts can lead to social disintegration, and the report documents cases of successful HIV prevention programs sabotaged by "rescue" operations.

In many countries (for example, China, India, Myanmar, and Sri Lanka) sex workers face a risk of compulsory detention in "rehabilitation" programs, sometimes for extended periods such as 1 year. Detainees are subject to compulsory medical examinations and forced labor, as well as "re-education."

An empiric analysis of STI clinics in Guangxi Providence, China, showed that cities where sex workers were detained had a higher mean HIV prevalence compared with cities that did not. UN recommendations urge closure of these detention centers, and advise that stigmatizing programs be replaced with evidence-based, voluntary, community-empowerment services.

The report also highlights some laws that currently protect certain rights of sex workers, helping to reduce HIV vulnerability. These include legislation in Vietnam that requires implementation of harm reduction interventions, prohibition of compulsory testing and rights to confidentiality, and a directive in Cambodia decreeing that condoms shall not be used as evidence in an arrest.

Whatever the legal regime, states are urged to ensure that sex workers are able to access HIV prevention, treatment, and care programs, and that there are protocols in place to protect sex workers from police abuse and exploitation.

At the report's launch Dhaliwal was quoted as saying, "Human rights are universal. It doesn't matter if you're a sex worker or a police officer or...a prime minister, we're all entitled to the same set of human rights."